Most people experience an occasional episode of stomach upset or indigestion that brings a few hours of discomfort and resolves on its own or with over-the-counter antacid medication.
 
Some of the more serious disorders of the stomach and stomach lining, such as gastritis and peptic ulcer disease, are more likely to develop gradually over time and progressively worsen unless diagnosed and properly treated. Their progression may also lead to dangerous situations, from internal bleeding, perforations and blockages to difficult-to-treat diseases such as gastric cancer.
 

Protecting the Stomach Lining

Cells in the lining of the stomach produce mucus and bicarbonate to protect the stomach lining against possible harm from acid, bacteria and digestive enzymes, which help break down food during the digestion process. While the mucus forms a layer of protection for the stomach lining, the bicarbonate helps to neutralize stomach acid. When these protective mechanisms are weakened or compromised, the stomach lining becomes more prone to gastritis and, potentially, peptic ulcer disease.

 

Understanding Gastritis and Peptic Ulcer Disease

Gastritis refers to inflammation of the stomach lining spanning acute gastritis, chronic gastritis and atrophic gastritis. Acute gastritis occurs suddenly and, in some cases, may progress to chronic gastritis. As chronic gastritis continues to progress over a long time period, it causes a slow, gradual wearing away of the stomach lining. Chronic gastritis may also result in dysplasia or metaplasia, which involve pre-cancerous cell changes that may eventually lead to cancer if left untreated.
 
Gastritis can cause erosions, or shallow sores, in the stomach lining, and the condition can lead to deeper, larger open sores called ulcers forming in the upper digestive tract, the primary indication for peptic ulcer disease. Ulcers located in the stomach lining are termed gastric ulcers, while ulcers that form at the beginning of the small intestine are duodenal ulcers. Some people develop both gastric and duodenal ulcers, while others have one but not the other.

Similarity in Key Causes

The two conditions share a number of similar causes. The two leading causes of both gastritis and peptic ulcer disease are infection with the Helicobacter pylori (H. pylori) bacterium and the use of aspirin, ibuprofen and other pain relievers known as non-steroidal anti-inflammatory drugs, or NSAIDs.
 
NSAIDs contribute to gastritis and peptic ulcer disease by inhibiting the production of an enzyme that would normally provide anti-inflammatory benefits to the stomach and help protect the stomach lining from harmful stomach acid.

 

The H. pylori bacteria infection causes the protective mucus in the stomach and duodenum to weaken, enabling acid to penetrate through to the lining. H. pylori bacteria and stomach acid cause irritation of the stomach lining and contribute to ulcers forming. H. pylori is also known to be a risk factor for gastric cancer. Though gastric cancer rates overall have been declining, the medical community generally favors treating H. pylori infection soon after it is detected, and antibiotic treatments are highly effective.
 
Genetics is believed to be a risk factor for peptic ulcer disease. Studies have shown that people with a family history of peptic ulcers were more likely to be diagnosed with the condition.

 

Main Symptoms and Similarities

Gastritis and peptic ulcer disease produce similar symptoms, though some patients with gastritis have no symptoms. Symptoms for both conditions may include:
 

• Dull or burning pain in the upper belly
• Feeling bloated
• Feeling full or satiated after only a small amount of food
• Heartburn, upset stomach
• Frequent burping
• Reduced appetite
• Nausea, together with or without vomiting

 

Alarm Symptoms

Not all stomach problems caused by acid turn out to be serious, and may respond well enough to over-the-counter antacids and pain relievers. But when stomach pain continues for at least two weeks, it should be treated as an alarm symptom — an important warning sign of a potentially serious underlying condition requiring urgent medical attention.
 
In addition to continuing pain, other alarm symptoms include:

• Anemia, which can result from blood loss due to a variety of factors, including ulcers, certain types of cancer, and the use of aspirin and other pain relievers
• Having black stools or reddish-colored stools, indicating the presence of blood.
• Nausea and vomiting, especially vomiting blood or having vomit that resembles dark coffee grounds
• Unexplained weight loss comprising about 10% of total body weight occurring over a period of several weeks to several months
• Persistent pain, especially “awakening pain”, which occurs during the night and is severe enough to cause you to suddenly wake up from sleep.

 

Diagnosis and Treatment

For gastritis and peptic ulcer disease, the first diagnostic step is determining whether H. pylori infection is present or not, since H. pylori typically requires a different type of treatment compared to cases of gastritis or peptic ulcer disease where H. pylori is not present. H. pylori testing can be performed with blood, breath, stool or issue/biopsy tests.
 
H. pylori treatment typically takes about two weeks, sometimes longer, and involves a combination of several medicines, including antibiotics to kill the bacteria and an acid-suppressing medication known as a proton pump inhibitor (PPI). Follow-up diagnostic testing is often recommended to confirm that the H. pylori infection has been successfully eliminated.
 
If an ulcer is suspected in the upper GI tract, your doctor may recommend a gastroscopy, an endoscopic procedure to visually inspect the inside of your stomach and small intestine. Endoscopy is a procedure in which a thin flexible tube with a tiny camera mounted on the tip is inserted down the throat and into the esophagus, stomach and small intestine. The camera can reveal potential ulcer sites, and the endoscope can take tissue samples for follow-up analysis.
 

Upper GI Series Imaging

Both gastritis and peptic ulcer disease may be diagnosed through a diagnostic endoscopy or an upper GI series test, also known as a barium swallow. The procedure involves a series of gastro-intestinal X-rays of the digestive system, including the stomach and small intestine. The patient swallows a chalky liquid containing barium, a substance which improves the visibility of any ulcers on X-ray images.
 

Acid-reducing Treatments

In gastritis or peptic ulcer disease cases that do not involve the H. pylori bacteria, most treatments involve medications such as antacids, histamine blockers and proton pump inhibitors, which inhibit the production of acid in the stomach. Most patients with peptic ulcer disease respond well to treatments using two or more types of medication to reduce acid and protect the lining of the stomach and duodenum. Treatment times can vary from several weeks to several months.
 

The Influence of Gut Microbiota

Looking beyond diseases of the stomach, a growing body of research on the micro-organisms populating the gastrointestinal tract — known as gut microbiota — is pointing to a potentially strong connection between imbalances in gut microbiota and inflammatory disorders such as obesity and type 2 diabetes, as well as infections and immune system disorders. With research continuing to expand the scientific community’s understanding of gut microbiota, the coming years could see a number of advances in disease prevention and treatment.
 
By Dr. Suriya Chakkaphak, Digestive Disease Center, Bumrungrad International Hospital